Interest and excitement in nanophotonics-the study and control of light-matter interactions at the nanoscale-are driven by the ability to confine light to volumes well below a cubic wavelength, and, thereby, achieve extremely high intensities. This leads to light-matter interactions of unprecedented localization and strength. Such extreme behavior-both in terms of field enhancement and localization-can be achieved using plasmonic nanostructures, which concentrate light in regions much smaller than the wavelength of light, reducing the excitation power and, under certain conditions, removing phase-matching requirements in the nonlinear regime. In this study, we theoretically show that metal-dielectric-metal (MDM) slot waveguides (WGs), consisting of a thin dielectric layer sandwiched between metal films, provide the strongest confinement. We also demonstrate that integrating epsilon-near-zero (ENZ) materials within the MDM slot significantly improves the nonlinear conversion efficiency of these structures. The results show that the degenerate four-wave mixing conversion efficiency of these ENZ-MDM structures surpasses that of regular plasmonic structures and their dielectric counterparts, even under low pump power conditions, and remains robust despite higher losses in the ENZ material.